TriZetto Achieves CMS Encounter Data End-to-End Testing Certification

The TriZetto Group, Inc., today announced that it has achieved certification in end-to-end testing from the Centers for Medicare and Medicaid Services (CMS) and is officially approved to begin submitting client claims that include professional encounter production data.

Encounter data include diagnosis and treatment information for all medical or behavioral services obtained by Medicare patients. CMS collects encounter data to determine risk-adjustment factors, analyze utilization, adjust plan payments and update risk-adjustment models for plan payment. With encounter data, CMS can take important steps toward improved beneficiary care, better overall health for plan participants and reduced healthcare costs.

“CMS this year requires Medicare Advantage plans to comply with encounter reporting and move from RAPS-based submissions to the new version HIPAA 5010, EDI837-format encounter data submissions,” explained Dave Abraham, general manager of TriZetto’s Medical Data Express (MDE) business unit. “TriZetto’s CMS certification is welcome news for our many Medicare Advantage clients. They’ll now be submitting CMS-compliant production data well ahead of the deadline.”

TriZetto streamlines claims submission and other administrative functions of more than 150 managed plans serving about 40 percent and 46 percent, respectively, of the nation’s Medicare and Medicaid beneficiaries.

“Our work for many clients makes TriZetto the reliable, go-to partner of choice in managed Medicaid and Medicare Advantage, distinguishing us from other firms that submit claims as a third-party,” said Becky Erbe, general manager of Medicare and Medicaid solutions at TriZetto. “We actively participate in the CMS encounter workgroups and training to share timely updates on new requirements that affect our clients, and TriZetto brings deep experience in encounter reporting in both Medicare Advantage and managed Medicaid.”

TriZetto acquired MDE, an industry leader in encounter data, earlier this year. Together, TriZetto and MDE offer a software solution that enables managed Medicare and Medicaid plans to aggregate, submit and follow up on encounter data in CMS- and state-required formats. The application also is available on a hosted basis.

About TriZetto

TriZetto provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. TriZetto solutions touch over half the U.S. insured population and reach more than 100,000 care providers. TriZetto helps healthcare organizations address compliance; enhance administrative efficiency; improve the cost, quality and delivery of care; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services. Provider solutions include real-time eligibility assurance and claims editing and revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit www.trizetto.com.